|
ELECTBICAL.INSPECTOR RECORD
<br />APPROVALS DATE rD/srG.COMMENTS OWNER BUII,DFJR DEI,CARATION
<br />I hcrsl,) ufli.n ufflcr Fnrlly of pcrjury thrt I !'n.rcnu fmm th. Co.lracrorc' Liccn* kw ror rh. following rcN,n (Scc 7031 5
<br />Busin.ss anl Prorr{sion C.d.)r Any Ciry or Counry slic! ,equircs r lcrmir ro con\ttucr. alrs, imrrovc. defr,lhh.r Eprn ooy
<br />slrucrurc. l)rhr to ns issu0tuc. al$ rcquics rhc lptli.0trr f(, su.h Fm b nh ! siBrcd stslcnrnr Ihrt lI or shc h liccnscd puaulnr
<br />lo rhc tmvhiotrl ofth. C.ntacroa\ t-i..n\cd l1s (Chsrrq g. ConnrcncinB wnh Se.ri.n 71XX) of Divhi.n :l ofrhc Buch.\a md
<br />Pmfc$ions Codc) or lhsr hc or shc kcxcmlr th.rctomand rhc hask lorrh.,llcgcdcxcnTrion Any violdion of Sdion 703 r.5 hy otry
<br />aptli.rnr for o pemir sutrccr\rhc {r,liconl ro acivilp.nahyoinot mre lh.n fivc hundrcd dollac (S50o).
<br />-1.
<br />$ owNr ol thc pmlEny. or nry cnrdorlrs wirh qa8cs,( rh.t *rr.conD.Nrri r. silld. rhc s'ort rfll rlf, itutrh is nor
<br />i .' .d or onird f{tr s,h l Sm 7(N4. arsnr\s lnd l\olt\sions C, d: lhc Cotrhrcktr s l-tcnse tiw dcs mr oplly ro an o*ncr ol
<br />lhc pmpcny wh.Itrills or iry,tr,rcs rher)n, ud *lxr ims $ch wor( him\clfor hcsclfor rhi{,ueh his or hcr .ei .nploydt\.
<br />pn,lidcd rhar \uch inpnNt f,nrsfl n inrcnddi o.or.rcd,{tr vlc lt hr$tkr.lh( hlilding orimpmBEnr h s,ld *irhin''nc Jrr
<br />oionrylcrion. rM Owrcr Buildcr will hrw ih. burdctr of!rcvine rhd tr or shr
<br />'lid
<br />ft, huild ur inqr.k rh. pn,Fny for rhL lDrDos ol
<br />l.urow.rofrl[pn,|Iny.rncrclusilclr.onr,cri',Swirhlircn\.{cotrtd.krsk,..nnrudrhct'mjccr(SLr.?01,1.Busncs
<br />rnd ltDt$in(hdc:IhcConrr.clolsLi.ctrscL.wdocstror.pflyloinoBnerotpnp.nyshotuil.l\orimprov.rrhcrcon.
<br />rnd who conhcrsirstr h projccr\ wirh u CoorDcrorl, liccnscd puFurtrr rorhcConrruck,\ I-iccne tiq)
<br />lrnc\cn,pr unJcr Sc.ri{n, .ll &1,( nnrrirr.x\otr
<br />lhlc llsn(r
<br />uaf,6l:&t-r!)utliNsa.IrlN
<br />DICI.Aa1IIIOIi
<br />I hcruhyrltu und.rIf,tulry.f lirjryotrc.frh.follosirgdel rri(rrs:
<br />Ihnv.dxlwilldrinlrinnCrcnill.rrcofConsclrbS.lflNlrcfrnworkc^.o,np,nralion,.stovidcdforh,Sr..lion]70Ootthe
<br />tiktrG c.lor lhc pcrformncc olrhc *o ru uhich lhc pcmit i\ issucd
<br />lh.rcafld williDidrin sorkcrs-.o'np.nsari insunicd. as dquncdhySc.rionl?mofrhcljbor('odc.lbrthcFrfornurccof
<br />rhc w.rk fuwhi.hrhk pcnnit is issu.d Mywork rs con'pcnern,n insuhtrcc crEict.nd pli.i nun$cr ac
<br />Poli.yNunrhcr: Exp c\
<br />_l ceniirrhrr n, rhc perlonutucorrhc wort fttr shichrhh Frnii h is\ucd- I shall nor .mrloy any p.r*n' in rny n'atrrcr
<br />s, N ro h...m $hfd tr rhc woAcri conlxntarion hw( or Calir nir. alnla8EcrhnrifI should hco'r suhjc( l.rhc
<br />lorkc* onr.ns.lioopslknrtrsofScciionlr00olrhcIjt rConc.I snrll. tunhwirhclmply withthoc provisions
<br />WARIiINC: Iailrc t, sur. sorkcr( conr.nsrrion covcrrtc i\ utrltrslnl and +rll suhjc.r rn rnrpk]!.r t,6i inrl Fn rs rnd
<br />:* a;rf i1T;*:k##0ffi -*- -
<br />DECI AR,{TNN
<br />I hcrhy drtrd utulcr F.alrt ol r.rtury rhdr I am lien$n undcr l,ovirtun or Chdprs 9 (.onmking w h s.crio. 7000) ol Oivision l
<br />of rhc Busincs\md l,nrtsions C.nc. ud nrylicen{ is ir lull,brcc. ctlcd
<br />AITLICANLILCLASAIIOtr
<br />I h.Eny anlnn undcr Fmhy of Frjury oru olllc followin! dccluitions
<br />Dcnbhliotr Pc nirsA\h. os Nnriil.ariotr ltd.nl Rcgukn tr lTirl.4{r, Pd6)
<br />Rcqun.d Lc(cr of Mnili.irnn
<br />-l.cnilrth
<br />rlrclidc.rlrcgularioN rc8trdirg ashnos nnivrl e. nor,ffli.nhlc tothis poj.cr
<br />-l
<br />cctrily rhnr I havcrcJd'hn.rp .nr ior i\ .om.t Irg(--t,.onflys(hrllCirlifld(otr v
<br />ruritri/rrcrrcvrn ivc\ olrh( Ciy rnd Counr!_ r,r cnr.r uF,, rh.oAlnancc\ ind Sr chwseli ir8 roiuiklir8
<br />r)rr rnrirnRt pmn.ny f{tr
<br />Qrcevn- C6^-11\ \-. t 1^^\l\
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />9igns (monument)
<br />Life Salety /Low Voltage
<br />lire Alarm / Dampers
<br />Bu ilding
<br />Under Slab / Floor
<br />Bondinq / Groundino i UFER
<br />To uerng
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Bqugh
<br />Service lvleler
<br />FINAL I \1o119 /,u/{6 )
<br />Notes, Remarks, Etc
<br />Site-Work
<br />Communications Cable
<br />Translormers
<br />A l\.\!w,t >
<br />IONSIB!]EIIAN.LDIDINIiIGEXII
<br />I hcreby !fltm unds rEnolry ot lcrjury rhar there n a consrrucrion lcnditrs ase.cy aor rhe Frformncc ol rh. xo.t r.r whi.h lhh tmnir il
<br />hsucd(S( 1097. Civ. C )
<br />txnd^.. No r
<br />L,1dc'', AdJ.s
<br />----+---
<br />I
<br />=
|